Terbinafine

Terbinafine is an antifungal drug for systemic and external use, a broad spectrum of antimycotic activity.

The main active component of the tablets Terbinafine blocks the intracellular biosynthesis of sterols necessary for the cell wall. This leads to suppression of growth and reproduction of fungal cells (fungistatic action) or their death (fungicidal action).

The highest concentration of the drug in the blood is observed 2 hours after the 250 mg tablet was taken. 99% of the active substance in the blood binds to plasma proteins.

Clinical and pharmacological group

Antifungal drug.

Terms of sale from pharmacies

Can buywithout a doctor's prescription.

Price

How much does terbinafine cost in pharmacies? The average price in 2018 is at the level of 250 rubles for 10 tablets, while the ointment will cost 60 rubles per tube of 15 mg.

Composition and form of release

Terbinafine tablets have a round shape, white or white with a yellow tinge color. The main active ingredient of the drug is terbinafine, its content in one tablet is 250 mg. It also includes auxiliary components, which include:

• Magnesium stearate.
• Giprolose.
• Colloidal silicon dioxide.
• Microcrystalline cellulose.
• Croscarmellose sodium.
• Lactose monohydrate.

Tablets are packaged in a contour squamous pack of 7 and 10 pieces. A cardboard bundle contains 1, 2 or 4 contour squares with the appropriate number of tablets, as well as instructions for the use of the preparation.

pharmachologic effect

Terbinafine suppresses the initial stage of the synthesis of sterols in the membrane of the fungal cell, leading to a deficiency of ergosterol and to intracellular accumulation of squalene, which causes the death of the microorganism cell. The action of terbinafine is carried out by inhibiting the enzyme squalene epoxidase in the cell membrane of the fungus. When ingested, drug concentrations are created that provide a fungicidal effect.

After oral administration, the maximum active substance concentration in the blood plasma is reached after two hours. In the process of long-term therapy, it accumulates in the stratum corneum of the skin and nails. The drug is metabolized by the liver, excreted by the kidneys, partially through the skin. It is excreted in breast milk through the mammary glands during lactation in women. In patients with impaired renal and hepatic function, the withdrawal of the drug from the body slows down, which leads to higher concentrations in the blood.

Indications for use

Terbinafine in the form of tablets is prescribed for the treatment of the following diseases:

1. Candidiasis of mucous membranes and skin.
2. Heavy, common dermatomycosis smooth skin of the trunk and extremities that require systemic treatment.
3. Mycosis of the scalp (microsporia, trichophytosis).
4. Fungal skin and nail lesions (onychomycosis) caused by Epidermophyton floccosum, Microsporum spp. (M. gypseum, M. canis) and Trychophyton spp. (T. mentagrophytes, T. rubrum, T. tonsurans, T. verrucosum, T. violacium).

Terbinafine is applied externally if the following indications are available:

1. Microsporum canis (treatment and prevention).
2. Multicolored lichen (Pityriasis versicolor), caused by Pityrosporum orbiculare (also known as Malassezia furfur).
3. Yeast infections of the skin, mainly caused by the genus Candida, in particular diaper rash.
4. Fungal skin infections, including foot mycoses (foot fungus), inguinal epidermophyte (tinea cruris), fungal lesions of smooth skin of the body (tinea corporis), caused by such dermatophytes as Trichophyton (in t.ch. T. mentagrophytes, T. rubrum, T. violaceum, T. verrucosum), Epidermophyton floccosum.

Read also: how to treat nail fungus at home.

Contraindications

Terbinafine exerts a severe load on the liver, and can affect the kidneys that excrete metabolites of the drug. Therefore, the contraindications for the use of terbinafine are as follows:

• the period of breastfeeding;
• lactose intolerance;
• chronic and acute liver disease;
• chronic renal failure, in which glomerular filtration - less than 50 ml / min on the basis of a sample of Reberg;
• age is less than 3 years;
• body weight less than 20 kg;
• glucosogalactose malabsorption;
• sensitivity or allergy to any components of the drug.

These pathological conditions are an absolute contraindication to the administration of terbinafine. In addition to absolute contraindications, there are a number of conditions in which taking the drug is possible, but with care and regular monitoring of the functioning of the body.

Precautions Terbinafine may be used in the following pathologies:

• endocrine diseases;
• narrowing of the vessels of the limbs;
• chronic renal failure, in which glomerular filtration - more than 50 ml / min on the basis of a sample of Reberg;
• alcoholism;
• violation of hematopoiesis;
• tumors;
• cutaneous lupus erythematosus and systemic lupus erythematosus;
• psoriasis.

On the background of taking terbinafine, it is necessary to monitor the liver and kidneys. If the following symptoms appear, the drug should be immediately discontinued:

• weakness;
• nausea;
• poor appetite;
• stomach ache;
• jaundice;
• dark urine;
• light feces.

Intended use for pregnancy and lactation

During the study, no teratogenic properties of the active substance were found. You can use terbinafine in pregnancy if the intended benefit is greater than the likely risk to the fetus.

Since the active ingredient is excreted with milk, lactation for the period of treatment should be discontinued.

Dosage and route of administration

As indicated in the instructions for use Terbinafine in the form of tablets are taken orally after meals.

The usual daily dose is:

• Adults and children from 3 years old with a body weight of more than 40 kg 5 g;
• Children from 3 years with a body weight less than 40 kg 25 g.

Multiplicity of reception of terbinafine - 1 time per day.

The duration of the therapeutic course is determined individually based on the severity of the disease and the localization of the process:

• Onychomycosis: 6-12 weeks (some patients with a reduced rate of nail growth may need a longer treatment period);
• Interdigital, type of "socks" or plantar infection localization: 2-6 weeks;
• Mycosis of other parts of the body (lower leg and trunk), as well as fungal infections caused by Candida fungi: 2-4 weeks;
• Mycosis of the scalp caused by fungi of the genus Microsporum: longer than 4 weeks (with infection of Microsporum canis may require longer therapy).

Elderly patients are prescribed Terbinafine without dose adjustment, patients with renal or hepatic insufficiency should be reduced in 2 times (25 g).

Ointment and Spray

Terbinafine in the form of an ointment and a spray is applied externally 1-2 times a day. Before applying the drug, the affected areas should be cleaned and dried.

The cream should be applied to the affected skin and adjacent areas with a thin layer and slightly rubbed. In infections that are accompanied by intertrigo (in the interdigital spaces, the groin area, between buttocks, under the mammary glands), the site of Terbinafine, especially at night, can be covered gauze.

The average duration of treatment and the frequency of application of the drug are:

• Dermatomycosis of feet, legs and trunk - 1 time per day for 1 week;
• Candidiasis of the skin 1-2 times a day for 1-2 weeks;
• Multicolored lichen - 2 times a day for 2 weeks.

As a rule, the decrease in the severity of clinical manifestations is noted in the first days of treatment. With irregular use or premature discontinuation of therapy, there is a risk of renewal of infection. If the improvement does not occur after 1-2 weeks of treatment, it is necessary to verify the diagnosis.

Side effects

The use of terbinafine (in the form of tablets) can cause the following side effects:

• Central nervous system: attacks of headache.
• The hemopoietic system: thrombocytopenia, neutropenia.
• Local reactions: burning sensation, itching, hyperemia.
• The digestive system: attacks of nausea, cholestasis, anorexia, hepatitis, mild abdominal pain, loss or violation of taste sensations, diarrhea, jaundice.
• Allergic manifestations: skin rashes; rarely - Stevens-Johnson syndrome, arthralgia, erythema multiforme, myalgia.

In places where the product is applied (in the form of a cream and spray), a burning or itching sensation, redness may appear. Allergic reactions are also possible.

Overdose

With an erroneous treatment regimen or with regular exceeding of the maximum daily dose of tablets, an overdose is possible, which is expressed in dizziness or headaches, vomiting, abdominal pain, rashes of unknown nature throughout body. If one or more of these symptoms appear, stop taking the medication and consult a doctor.

It will be necessary to carry out measures to remove the drug from the body. In some cases, symptomatic maintenance therapy is prescribed.

special instructions

Before you start using the drug, read the special instructions:

1. Irregular application or early termination of treatment increases the risk of relapse.
2. Removal of nail plates in the treatment of onychomycosis of brushes for 3 weeks and onychomycosis of the feet for 6 weeks is not required.
3. The administration of terbinafine to psoriasis patients requires caution. In very rare cases, terbinafine can provoke an exacerbation of psoriasis.
4. The duration of therapy can be influenced by factors such as the presence of concomitant diseases, the condition of the nails with onychomycosis at the beginning of the course of treatment.
5. If after 2 weeks of treatment for a skin infection there is no improvement, it is necessary to repeatedly identify the pathogen and its sensitivity to the drug.
6. In the presence of liver disease, terbinafine clearance can be reduced. During treatment, it is necessary to monitor the activity of "hepatic" transaminases in the blood serum.
7. Systemic use in onychomycosis is justified only in case of total defeat of most nails, the presence of pronounced subungual hyperkeratosis, ineffectiveness of previous local therapy.
8. In rare cases, after 3 months of treatment, there is cholestasis and hepatitis. When there are signs of impaired liver function (weakness, persistent nausea, decrease appetite, excessive abdominal pain, jaundice, darkening of the urine or discolored stool) the drug should cancel.
9. In the treatment of onychomycosis, a clinical response, confirmed laboratory, usually occurs after a few months after mycological cure and cessation of treatment, which is due to the rate of regrowth of a healthy nail.
10. When treating terbinafine, general hygiene rules should be followed to prevent the possibility of re-infection through linens and shoes. In the process of treatment (after 2 weeks) and at the end of it, it is necessary to produce antifungal treatment of shoes, socks and stockings.

Interaction with other drugs

When combined with ethanol or drugs that have a hepatotoxic effect, there is a risk of developing drug-induced liver damage.

Possible violation of the menstrual cycle with the simultaneous administration of terbinafine and oral contraceptives.
Terbinafine reduces caffeine clearance by 21% and prolongs its half-life by 31%. Does not affect the clearance of phenazone, digoxin, warfarin.

Inhibits the isoenzyme CYP2D6 and disrupts the metabolism of drugs such as tricyclic antidepressants and selective inhibitors reuptake of serotonin (eg, desipramine, fluvoxamine), beta-blockers (metoprolol, propranolol), antiarrhythmic agents (flecainide, propafenone), monoamine oxidase B inhibitors (eg selegiline) and antipsychotic (eg, chlorpromazine, haloperidol) funds.

Medications-inducers of cytochrome P450 isoenzymes (for example, rifampicin) can accelerate metabolism and excretion of terbinafine from the body. Drugs - inhibitors of cytochrome P450 isoenzymes (eg, cimetidine) can slow down metabolism and remove terbinafine from the body. With the simultaneous use of these preparations, a dose adjustment for terbinafine may be required.

Reviews

We offer you to read reviews of people who used the drug Terbinafine:

1. Maksim. I am a driver, I earned a nail fungus on my legs during long flights. First he tried to treat himself, but nothing happened, he went to the doctor. I did not believe that pills could help, but they helped. After treatment, I closely monitor the healthy nails, observe elementary hygiene, try to change socks more often.
2. Natalia. A very serious drug, it is necessary to use cautiously, in no case exceeding the dosage. My husband had a fungus on the inside of his thigh from the cat, which lay on his knees. Tried to cope with creams and ointments, but the radius of the circle of the fungal lesion only increased. I decided to take terbinafine tablets, but slightly increased the dosage so that the drug would act faster and more efficiently. The result - loss of appetite, dark urine, discolored cal. From the fungus healed, but I had to restore the liver for three more months.
3. Lyudmila. It has been helping my relative for several months already! On the upper part of the foot mycosis, the doctor prescribed a complex treatment, a diet, recommended even socks to boil every few months. It is not always possible to take other medications, but terbinafine itself works well, too. The relative takes in the form of an ointment. From the pros: it is available in most pharmacies (near the house there are several with different names, although there is always one), fast action (reducing the area of ​​the affected area, its color comes back to normal). Of the minuses: smelly it a little, in my opinion, but it should sniff.

Analogues

Structural analogs for the active substance:

• Atitis;
• Binafin;
• Lamisyl;
• Lamizil Dermgel;
• Lamizil Uno;
• Lamican;
• Lamella;
• Myconorm;
• Mycoterbine;
• Onihon;
• Tebicur;
• Terbized Agio;
• Terbisyl;
• Terbiks;
• Terbinafine Hexal;
• Terbinafine Pfizer;
• Terbinafine MFF;
• Terbinafine Sar;
• Terbinafine Teva;
• Terbinafine hydrochloride;
• Terbinox;
• Terbifin;
• Thermic;
• Tigal is a sanovel;
• Ungusan;
• Fungoterbine;
• Cidokan;
• Exeter;
• Exifin.

Before buying an analogue, consult your doctor.

Shelf life and storage conditions

Keep in a place protected from moisture and light out of the reach of children, tablets and cream at a temperature of no higher than 25 ° C, spray from 2 to 20 ° C.

Shelf life: tablets - 3 years; cream and spray - 2 years.

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